Hypertrophic scar and keloid are common pathological scars during skin wound healing, which seriously affect patients' appearance and quality of life. In recent years, with the development of molecular biology and medical technology, the understanding of their pathogenesis has been continuously deepened, and the treatment methods have become increasingly diversiffed. A variety of molecular markers such as PAI-1, TLR4, Periostin and miR-27a-3p play important roles in the formation of pathological scars, and the abnormal activation of the MAPK signaling pathway is a key pathological link. Clinically, physical therapies including laser, radiofrequency and photodynamic therapy, drug therapies such as glucocorticoids and silicone gel, as well as comprehensive treatment regimens such as surgical excision combined with radiotherapy have all shown favorable efffcacy. Evaluation tools such as the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale provide an objective basis for therapeutic effect evaluation. This paper systematically reviews the molecular pathogenesis, inffuencing factors, comprehensive treatment methods and efficacy evaluation systems of hypertrophic scar and keloid, aiming to provide a reference for clinical diagnosis and treatment.